Surgical devices controllable by surgical robotic systems

ABSTRACT

A surgical device controllable by a surgical robotic system is provided. The surgical device includes a housing capable of being coupled to the surgical robotic system, a drive system at least partially mounted in the housing; and a shaft rotatably coupled to the drive system at a first end of the shaft. The surgical device further includes a tissue-removal assembly coupled to the second end of the shaft. The tissue-removal assembly includes a first cutting member having a plurality of rotatable blades. The first cutting member is coupled to a second end of the shaft. The tissue-removal assembly further includes a second cutting member, one or more support elements slidably or fixedly coupled to the second cutting member, and one or more extendable elements slidably or fixedly coupled to the second cutting member.

CROSS REFERENCE TO RELATED APPLICATIONS

-   -   This application is a continuation of International Application        Number PCT/CN2020/094366 filed on Jun. 4, 2020. The entire        contents of this application is hereby incorporated herein by        reference for all purposes.

FIELD OF THE DISCLOSURE

The present disclosure generally relates to a robotic system combinedwith surgical devices and, more specifically, to a surgical deviceintegrated with a surgical robotic system for performing a spinesurgery.

BACKGROUND

Vertebral disc herniation or degeneration is a common disorder where aportion of a vertebral disc, a cushion-like structure located betweenthe bones of the spine, bulges out or extrudes beyond the usual marginsof the disc and the spine. Disc herniation or degeneration is believedto be the result of a loss of elasticity of the tissue comprising thedisc. They are typically associated with increasing age. Disc herniationor degeneration and other degenerative disc diseases are also associatedwith spinal stenosis, a narrowing of the bony and ligamentous structuresof the spine. Although disc herniation or degeneration can occuranywhere along the perimeter of the disc, it occurs more frequently inthe posterior and posterior-lateral regions of the disc, where thespinal cord and spinal nerve roots reside. Compression of these neuralstructures can lead to pain, parasthesias, weakness, urine, and fecalincontinence and other neurological symptoms that can substantiallyimpact basic daily activities and quality of life.

Temporary relief of the pain associated with disc herniation ordegeneration is often obtained using conservative therapy, whichincludes positional therapy (e.g. sitting or bending forward to reducepressure on spine), physical therapy, and drug therapy to reduce painand inflammation. When conservative therapy fails to resolve a patient'ssymptoms, surgery may be considered to treat the structural source ofthe symptoms. Surgical treatments for disc herniation or degenerationtraditionally involve open procedures that require extensive dissectionof muscle, connective tissue, and bone along a patient's back to achieveadequate surgical exposure, and sometimes the procedure will requireimplantation of foreign material inside patient's body. These surgeriesalso expose the patient to a significant risk of complications, due tothe presence of critical neurovascular structures near the surgicalsite. A discectomy procedure is one of such surgeries. A discectomyprocedure surgically removes abnormal disc material that presses on anerve root or the spinal cord. A discectomy procedure may be used todecompress the herniation by accessing the affected disc and removing aportion of the disc and any loose disc fragments. To achieve sufficientaccess to the affected disc, a portion of the lamina or bony arch of thevertebrae may be removed, thereby increasing the invasiveness of theprocedure. When discectomy fails to resolve a patient's symptoms, moredrastic measures may include disc replacement surgery or vertebralfusion that requires thorough discectomy and endplate decortication.

SUMMARY OF THE DISCLOSURE

The following presents a simplified summary of one or more examples inorder to provide a basic understanding of the disclosure. This summaryis not an extensive overview of all contemplated examples and is notintended to either identify key or critical elements of all examples ordelineate the scope of any or all examples. Its purpose is to presentsome concepts of one or more examples in a simplified form as a preludeto the more detailed description that is presented below.

Systems and methods for performing surgical procedures using a surgicaldevice controllable by a surgical robotic system are described. Thesurgical device can be used for treating disc herniation ordecompression, disc degeneration, bone decortication, spinal fusion,spinal deformity, and vertebral body fracture. Such surgical proceduresinclude surgical robotic and/or minimally invasive access or endoscopicaccess and removal of disc tissue. In some embodiments, a surgicaldevice controllable by a surgical robotic system is provided. Thesurgical device includes a housing capable of being coupled to thesurgical robotic system; a drive system at least partially mounted inthe housing, and a shaft rotatably coupled to the drive system at afirst end of the shaft. The surgical device further includes atissue-removal assembly coupled to the second end of the shaft. Thetissue-removal assembly includes a first cutting member having aplurality of rotatable blades. The first cutting member is coupled to asecond end of the shaft. A cross-section of the first cutting memberhaving the plurality of rotatable blades forms a polygon. Thetissue-removal assembly further includes a second cutting member, one ormore support elements slidably or fixedly coupled to the second cuttingmember, and one or more extendable elements slidably or fixedly coupledto the second cutting member. The one or more support elements and theextendable elements are extendable and retractable to adjust theposition of the second cutting member with respect to the first cuttingmember.

In some embodiments, a surgical robotic system is provided. The surgicalrobotic system includes, among other things, a robotic controller, arobotic arm controlled by the robotic controller, and a surgical device.The surgical device includes a housing capable of being coupled to thesurgical robotic system; a drive system at least partially mounted inthe housing; and a shaft rotatably coupled to the drive system at afirst end of the shaft. The surgical device further includes atissue-removal assembly coupled to the second end of the shaft. Thetissue-removal assembly includes a first cutting member having aplurality of rotatable blades. The first cutting member is coupled to asecond end of the shaft. A cross-section of the first cutting memberhaving the plurality of rotatable blades forms a polygon. Thetissue-removal assembly further includes a second cutting member, one ormore support elements slidably or fixedly coupled to the second cuttingmember, and one or more extendable elements slidably or fixedly coupledto the second cutting member. The one or more support elements and theextendable elements are extendable and retractable to adjust theposition of the second cutting member with respect to the first cuttingmember.

In some embodiments, a method is provided for placing an interbodyimplant in a spine of a patient using a robotic system. The roboticsystem includes a robotic manipulator and an insertable surgical devicecoupled to the robotic manipulator to advance and insert the interbodyimplant inside the spine. The method includes controlling movement ofthe insertable surgical tool to place the interbody implant along adesired trajectory. The method also maintains the desired trajectory forthe discectomy process and controls installation of the interbodyimplant in the spine of the patient so that the interbody implant isplaced at a desired location. Controlling installation of the interbodyimplant includes causing autonomous movement of the insertable surgicaldevice to place the interbody implant in the spine of the patient untilthe interbody implant is within a predefined distance of the desiredlocation. Thereafter, manual manipulation of the insertable surgicaldevice can be controlled until the interbody implant is placed at thedesired location.

It should be appreciated that the systems and methods described hereincan be employed to remove tissue during a discectomy procedure andinsert interbody implant into a patient. So, even though tissue removalduring the discectomy procedure and insert interbody implant arereferenced throughout as one example, the same systems and methodsdescribed herein could be utilized for treating any anatomy of thepatient and/or for placing any implants into the patient, e.g., in theknee, hip, shoulder, spine, cranial, and other parts of the bodies, etc.For instance, the robotic controller and robotic manipulator may also beused to provide a trajectory to the pedicle of the spine, place apedicle screw for a spine implant, place rods, place other components,and/or drill a pilot hole or other procedures. Different end effectorsor surgical devices can also be attached to the robotic manipulator forother procedures. In some cases, the end effector or surgical device mayalso have an articulating arm to facilitate implant insertion, i.e.,placing the implant in a desired position.

BRIEF DESCRIPTION OF THE DRAWINGS

For a better understanding of the various described aspects, referenceshould be made to the description below, in conjunction with thefollowing figures in which like-referenced numerals refer tocorresponding parts throughout the figures.

FIG. 1 illustrates an exemplary surgical robotic system for performingan orthopedic surgery.

FIG. 2 illustrates an exemplary robotic manipulator of the exemplaryrobotic surgical system of FIG. 1.

FIG. 3 illustrates an exemplary navigation system of the surgicalrobotic system and a surgical device coupled to the surgical roboticsystem for performing an orthopedic procedure.

FIG. 4 illustrates an exemplary robotic arm of the surgical roboticsystem and an exemplary surgical device coupled to the robotic arm.

FIGS. 5A-5C illustrate an exemplary surgical device that is controllableby a surgical robotic system to place a tissue-removal assembly of thesurgical device in different profiles.

FIG. 6 illustrates an exemplary surgical device being used in adiscectomy procedure for a disc space.

FIG. 7 is a schematic perspective view and superior view of a portion ofa lumbar spine.

FIG. 8 is an enlarged view and a cross-sectional view of a portion ofthe surgical device of FIG. 6.

FIG. 9 illustrates a plurality of exemplary cross-sectional shapes of acutting member of an exemplary tissue-removal assembly.

DETAILED DESCRIPTION

The detailed description set forth below in connection with the appendeddrawings is intended as a description of various configurations and isnot intended to represent the only configurations in which the conceptsdescribed herein may be practiced. The detailed description includesspecific details for the purpose of providing a thorough understandingof various concepts. However, it will be apparent to those skilled inthe art that these concepts may be practiced without these specificdetails. In some instances, well-known structures and components areshown in block diagram form in order to avoid obscuring such concepts.

Surgeries or procedures are usually performed by surgeons manually. Forexample, in a spine procedure, a surgeon may need to manually removetissues using a surgical device. To complete such as procedure, thesurgeon may need to insert the surgical device into the patient's spinearea and repeatedly cutting tissues. Sometimes, the surgeon needs torepeat the cutting operations dozens or even hundreds of times. Thus,the procedure can be very long and tiring for the surgeon. The prolongedprocedure also increases the risk of making mistakes and reduces theprecision or accuracy of tissue cuttings during the procedure.Therefore, there is a need to increase the efficiency, precision, andreproducibility of the surgical procedures by integrating surgicaldevices with a surgical robotic system. There is also a need to improvethe surgical device itself such that tissue removal can be moreaccurate, precise, and efficient.

In some embodiments, a surgical device described in this disclosureincludes a tissue-removal assembly that has a first cutting member. Thefirst cutting member includes a plurality of rotatable cutters or bladesformed along a longitudinal direction of the first cutting member. Thecross-section of the first cutting member forms a star-shaped polygon.The plurality of the rotatable blades of the first cutting member,together with the auger on the shaft coupled with the first cuttingmember and an extendable second cutting member, provide a vortex effectflow control for controlling the flow of the removal of the tissue andfluid (e.g., blood) during the performance of the surgical procedures.Thus, the disclosed first cutting member, the extendable second cuttingmember, and the auger on the shaft improve the flow control of tissueremoval. The tissue removal during the flow control can be as much as0.1 cubic centimeters per minute (cc/minute) to 10 cc/minute dependingon one or more of the size of the outer tube, the size of the firstcutting member, the size of the second cutting member, and the size ofthe auger on the shaft.

Moreover, the tissue-removal assembly of the surgical device can alsoinclude one or more extendable elongated members, such as tube and/or acable. The tissue-removal assembly can thus be more easily inserted intoa vertebral disc. As disclosed below in more detail, the tissue-removalassembly can further include a second cutting member. The second cuttingmember can be controlled (e.g., by the robotic system) to be in aretracted or deployed configuration. The disclosed first cutting membercan be controlled (e.g., by a robotic system) to rotate at a desiredspeed, and therefore can pulverize tissue on a narrow or collapsed discprior to deploying the second cutting member. Therefore, the firstcutting member having a plurality of rotatable blades can furtherimprove the pulverizing of the disc material and facilitate a smootherremoval of tissue and/or fluid in a collapsed disc. In some embodiments,the surgical device can further include a shaft, a plurality of supportelements, and a plurality of extendable elements. The support elementsand extendable elements can include, for examples, cables with aretracted and a deployed configuration. One or more of these cables maybe distally supported by a movable rigid element that restrains thedistal end of the cables to be within a fixed distance from the shaft ofthe surgical device. In some embodiments, the second cutting member ofthe tissue-removal assembly can be coupled to the support elements andextendable elements. The second cutting member includes, for example, arotatable blade, cutter, or cutters to pulverize tissue when the secondcutting member is controlled (e.g., by the robotic system) to be placedin a partially or entirely deployed configuration.

In some embodiments, the surgical device described herein includes ahousing mechanically and electrically coupled to a robotic arm (e.g., apower connector for electrical connection), a tissue collection chamber,a steering mechanism, and a drive system (e.g., a motor configured torotate at a variable speed of at least 1,000 rpm). The surgical devicecan also include an inner shaft and an outer tube enclosing at least apart of the inner shaft. In some embodiments, the outer tube has abeveled distal end and a proximal end attached to the housing. The outertube may have, for example, a length of about 5 centimeters (cm) toabout 40 cm. An average diameter of the outer tube that encloses atleast a part of the inner shaft is, for example, less than about 4millimeters (mm). The inner shaft can include a blunt proximal end thatmay be enclosed by the outer tube and coupled to the drive system (e.g.,a motor). The inner shaft can also include an elongated member extendingthrough an opening of the distal end of the outer tube. The inner shaftcan be coupled to the tissue-removal assembly using, for example, areinforcing ring.

In some embodiments, one or more support elements can be coupledproximally to the inner shaft and distally to the elongated member ofthe inner shaft. The elongated member may be joined to a support elementby, for example, a hinge mechanism. The hinge mechanism may beconfigured to generally limit the relative movement between theelongated member of the inner shaft and a support element to a planethat is generally defined by the elongated member and the supportelement.

A robotic system can be controlled to perform surgeries such as delicatespine surgeries. One of such spine surgeries can place pedicle screws ina patient's spine. When a patient requires surgery that involves placingpedicle screws, pre-operation images and/or intra-operation images ofthe patient's spine are obtained. A surgeon then plans where to placethe pedicle screws with respect to the images and/or with respect to a3-D model generated from the images. Planning includes, for example,determining a position and orientation of each pedicle screw withrespect to the particular vertebra in which they are being placed, e.g.,by identifying the desired position in the images and/or the 3-D model.Once the plan is determined, it is transferred to the robotic system forexecution.

Typically, a robotic system includes a robotic manipulator (e.g., one ormore robotic arms) that can position a tool guide above the patient andalong a desired trajectory that is aligned with the desired orientationor trajectory of the pedicle screw to be placed. The robotic system alsoincludes a navigation system to determine a location of the tool guidewith respect to the patient's anatomy so that the robotic manipulatorcan place the tool guide along the desired trajectory according to thesurgeon's plan. In some cases, the navigation system includes one ormore tracking devices attached to the robotic manipulator and to thepatient so that the robotic system can monitor and respond to movementof the patient during the surgical procedure by moving the tool guide asneeded to maintain the desired trajectory.

After the tool guide has been positioned in alignment with the desiredtrajectory, the robotic manipulator is controlled to maintain thealignment. Thereafter, a surgeon positions a cannula through the toolguide and adjacent to the vertebra. The surgeon inserts a conventionaldrilling tool into the cannula to drill a pilot hole for the pediclescrew. The surgeon then removes the drilling tool and drives the pediclescrew into position in the pilot hole with a pedicle screwdriver. Inthis methodology, the robotic manipulator may be somewhat underutilizedas the robotic manipulator plays little to no role in drilling the pilothole or inserting the pedicle screw. Various embodiments of the surgicaldevice disclosed in this disclosure can be controlled by the roboticsystem to improve or enhance of the use of the robotic manipulator invarious spine surgeries.

FIG. 1 illustrates an exemplary surgical robotic system 100 forperforming an orthopedic surgery in some embodiments, the robotic system100 includes a robotic manipulator 40 and a navigation system 10. FIG. 2illustrates an exemplary robotic manipulator 40. FIG. 3 illustratesexemplary navigation system 10 and a surgical device 20 coupled to therobotic manipulator 40 of the robotic system 100. With reference toFIGS. 1, 2, and 3, a surgical robotic system 100 is illustrated.Surgical robotic system 100 can be used in various surgical procedures,including, but not limited to, knee, hip, and spine procedures. Forexample, surgical robotic system 100 can be coupled to a surgical device(e.g., surgical device 20 shown in FIG. 3) to perform a tissue removalprocedure, interbody implants positioning, or trajectory or placementsof screws or rods, other types of implants placed in spine, bonedecortication, dural repair, and/or other spine procedures. The surgicaldevices 20 coupled to the robotic system 100 can be the same ordifferent for different procedures.

As shown in FIGS. 1-3, in some embodiments, robotic manipulator 40 ofsurgical robotic system 100 includes a base 51, a robotic controller 90,a robotic arm 50, and one or more displays 13A (one such display isshown). The robotic arm 50 can includes a base link 52 rotatably coupledto the base 51 and a plurality of arm links 53 serially extending fromthe base link 52 to a distal end 54. The arm links 53 can pivot and/orrotate about a plurality of joints in the robotic arm 50, with a minimumthree degrees of freedom. In one preferred embodiment, the arm links 52has a seven degrees of freedom. FIG. 3 further illustrates a surgicaldevice 20 coupled to the distal end 54 of robotic arm 50. The surgicaldevice 20 can be controlled by the robotic system 100 (e.g., controlledby robotic controller 90 via arm links 53) to perform various spineprocedures. A surgical device can be a discectomy surgical tool, aninserter for the interbody implant, an inserter for a pedicle screw, abone decorticator, a saw, a drill, or the like. The surgical device 20may be pivotally connected to the distal end 54 of the robotic arm 50.Another preferred embodiment may be that the base link 52 is notconnected to the base 51, rather the base link 52 is locked to thebedside independently (not shown). In this embodiment, the communicationbetween the base 51 and the robotic arm 50 can be via. Bluetooth orWi-Fi connection. One embodiment of the robotic arm 50 is that therobotic arm manufactured by AUBO Robotics China, located at 3^(rd)Floor, Shilong Sunshine Building No. 98 of Lianshihu West Road, Beijing,China or its USA office AUBO Robotics USA located at 2704 Chekokee FarmWay, Suite 203, Knoxville, Tenn. 37920 USA.

With reference to FIGS. 1-3, a robotic controller 90 can be configuredor programmed to provide control of the robotic arm 50 or guidance tothe user (e.g., a surgeon) during manipulation of the surgical device 20(e.g., as shown in FIG. 3). In one embodiment, using the roboticcontroller 90, the robotic arm 50 can operate autonomously based onpredefined robotic arm trajectory or paths and/or other predefinedmovements to perform the surgical procedure. Such movements may bedefined during the surgical procedure and/or before the procedure. Insome embodiments, surgical robotic system 100 (shown in FIG. 1) canallow a combination of manual and autonomous control of the robotic arm50. For example, the surgical robotic system 100 can be configured orprogrammed to operate in a manual mode and/or a semi-autonomous mode. Inthe manual mode, a user applies force to the surgical device 20 to causemovement of the robotic arm 50. In a semi-autonomous mode, a user holdsa pendant to control the robotic arm 50 to autonomously follow a toolpath or a tool action.

FIGS. 1-3 demonstrates that the surgical robotic system 100 has a singlerobotic arm 50. It is appreciated that one or more additional roboticarms can be integrated or included in robotic system 100. In someembodiments, a robotic system may include more than one robotic armconfigured or programmed to perform different operations or functions ofa procedure simultaneously. For example, a first robotic arm can becontrolled to perform discectomy procedure, while a second robotic armcan be controlled to perform alignment and trajectory for the pediclescrews.

As shown in FIGS. 1-3, one or more displays 13A can display, forexample, one or more user interfaces to provide user interaction withrobotic manipulator 40. For example, displays 13A can facilitate theconfiguration or programming of robotic controller 90, defining therobotic arm trajectory, providing visual and/or audio feedback to theuser, monitoring the movements of the robotic arm 50, etc.

As shown in FIGS. 1 and 3, in some embodiments, the surgical roboticsystem 100 includes a navigation system 10. In some embodiments, thenavigation system 10 can be configured to track movement of variousobjects in the operating room (e.g., a surgery room) with respect to atarget coordinate system. Such objects include, for example, thesurgical device 20, the patient's anatomy of interest, e.g., one or moreof disc space, pedicle, vertebra, dural, and/or other objects. Thenavigation system 10 can track these objects and display their relativepositions and orientations in the target coordinate system to thesurgeon. Displaying such tracking data can be performed using one ormore displays 13B. In some embodiments, the navigation system 10 cantrack these objects for constraining movement of the surgical device 20relative to one or more virtual boundaries associated with the patient'sanatomy and defined with respect to the target coordinate system (e.g.,via coordinate system transformations used in surgical navigation).

In some embodiments, the navigation system 10 includes a computer cartassembly 14 that houses a navigation controller 15. The navigationcontroller 15 and the robotic controller 90 can collectively form acoordinated control system of the surgical robotic system 100.Navigation system 10 can further include a navigation interface, whichcan be in operative communication with the navigation controller 15. Thenavigation interface includes the displays 13B that are adjustablymounted to the computer cart assembly 14. Input devices such as akeyboard and mouse 16 can be used to facilitate user interaction with(e.g., input information into) the navigation controller 15 or otherwiseselecting/controlling certain aspects of the navigation controller 15.It is appreciated that other input devices can also be used tofacilitate the user interaction with navigation controller 15. Suchinput devices may include a touch screen (not shown), a joystick, avoice-controlled system, or the like.

With reference to FIG. 3, navigation system 10 can further include alocalizer 11 and one or more tracking devices 12. The localizer 11 cancommunicate with the navigation controller 15 (e.g., using wired orwireless communication to provide data to, and/or receive data from,navigation controller 15). In the embodiment shown in FIG. 3, thelocalizer 1 is an optical localizer and includes a camera unit (e.g., asensing device). The camera unit has an outer casing that houses one ormore optical position sensors. In some embodiments, at least two opticalposition sensors are used. In some embodiments, three or more opticalposition sensors are used (e.g., to improve on position sensingaccuracies). The optical position sensors can be, for example, separatecharge-coupled devices (CCD). In some embodiments, the camera unit oflocalizer 11 is mounted on an adjustable arm to position the opticalposition sensors corresponding to a field-of-view of the one or moretracking devices 12. The field-of-view associated with the opticalposition sensors of localizer 11 are preferably free from obstructionssuch that the sensing of the position or orientation information is notaffected.

In some embodiments, the localizer 11 can include a 3-dimensional (3D)sensor that can obtain imaging data associated with the patient's innerbody (e.g., the patient's organs, tissues, spine, etc.). Such a 3Dsensor can see through the patient's body and thus improve the precisionof the surgical procedures. A 3D sensor can also be used to provideintra-operative images of the device positions and trajectories, withoutthe need to confirm with the standard C-Arm fluoroscopy equipment. Insome embodiments, the sensing or imaging device (not shown) may be aportable Magnetic Resonance Imaging (MRI) that is an independent deviceor it can be part of the attachment of the robotic arm 50, to offer theintraoperative images of device positions and trajectories withouthaving to confirm with the standard C-Arm fluoroscopy equipment. It isappreciated that while FIGS. 1 and 3 illustrate navigation system 10 androbotic manipulator 40 as two separate systems, they can be integratedor combined in any desired manner. For example, one or more componentsor sub-systems of navigation system 10 (e.g., the localizer 11 can beintegrated with robotic arm 50).

Referring to FIG. 3, navigation system 10 can also include a pluralityof tracking devices 12, also referred to herein as trackers. In someembodiments, tracking devices 12 can include one or more trackerscoupled to different portions of the surgical robotic system 100. Forexample, trackers 12 can be coupled to the patient, to the base ofrobotic system, and to the surgical device. In the illustratedembodiment in FIG. 3, trackers 12 can be coupled to patient's skin, discspace, pedicle, vertebra, or spinous process of the patient. In someembodiments, the trackers 12 are firmly affixed to sections of discpace, pedicle, vertebra, bone via bone screws, patient's skin or thelike. In some embodiments, clamps on the spinous process or otherportion of the spine may be used to attach the trackers 12. In furtherembodiments, the trackers 12 can be mounted to other tissue types orparts of the patient's anatomy. The position of the trackers 12 relativeto the anatomy to which they are attached can be determined byregistration techniques, such as point-based registration in which adigitizing probe 17 (e.g., navigation pointer with its own markers) isused to touch off on bony landmarks on the bone or to touch on severalpoints on the bone for surface-based registration. Conventionalregistration techniques can be employed to correlate the position of thetrackers 12 to the patient's anatomy, e.g., the disc space, pedicle orvertebra being treated. Digitizing probe 17 can be a separate devicefrom surgical robotic system 100 or can be integrated with surgicalrobotic system 100.

As described above, a tracker 12 can also be coupled to a base of thesurgical robotic system 100. Such a tracker 12 is referred to as a basetracker. For example, a base tracker 12 can be coupled to the base 51 totrack the position of the surgical device 20. In some embodiments, asshown in FIG. 3, a separate tracker 12 can be coupled to the surgicaldevice 20. For example, a tracker 12 can be integrated into the surgicaldevice 20 during manufacturing or may be separately mounted with acoupler 55 to the surgical device 20 in preparation for the surgicalprocedures. Regardless of the manner of coupling tracker 12 to thesurgical device 20, an operating end of the surgical device 20 can betracked using a base tracker 12, a tracker 12 mounted directly onsurgical device 20, other trackers, or a combination thereof. Theoperating end of surgical device 20 may be a distal end of an accessoryof the surgical device 20. Such accessories may comprise a discectomysurgical tool, an inserter to insert interbody, a screw driver to placepedicle screws, an ablation device, a saw, a drill, a knife, a bonedecorticator, a K-wire, a guiding pin, or the like.

In some embodiment, the trackers 12 are passive trackers. For example,each tracker 12 has at least one passive tracking elements or markersfor reflecting light from the localizer 11 back to the optical sensorsincluded in the localizer 11. In some embodiments, the trackers 12 areactive trackers and may have light emitting diodes or LEDs transmittinglight, such as infrared light to the optical sensors of localizer 11.Based on the received optical signals, navigation controller 15generates data indicating the relative positions and orientations of thetrackers 12 relative to the localizer 11 using, for example,triangulation techniques. In some cases, more or fewer markers may beemployed. For instance, in cases in which the object being tracked isrotatable about a line, two markers can be used to determine anorientation of the line by measuring positions of the markers at variouslocations about the line. It should be appreciated that the localizer 11and trackers 12, although described above as utilizing optical trackingtechniques, can alternatively, or additionally, utilize other trackingmodalities to track the objects, such as electromagnetic tracking, radiofrequency tracking, inertial tracking, three-dimensional tracking,combinations thereof, or the like.

In some embodiments, the robotic controller 90 and the navigationcontroller 15 may each, or collectively, include one or more memorysuitable for storage of data and computer-readable instructions, such asnon-transitory computer readable memories, local memory, externalmemory, cloud-based memory, flash memory, or any other suitable form ofmemory. The robotic controller 90 and the navigation controller 15 mayeach, or collectively, comprise one or more processors, such asmicroprocessors, for processing instructions or for processingalgorithms stored in memory to carry out the functions described herein.The processors can be any type of processor, microprocessor ormulti-processor system, or ASIC systems, discrete circuitry, and/orother suitable hardware, software, or firmware that is capable ofcarrying out the functions described herein. The robotic controller 90and the navigation controller 15 may be carried by the roboticmanipulator 40, the computer cart assembly 14, and/or may be mounted toany other suitable location. The robotic controller 90 and/or thenavigation controller 15 can be loaded with hardware, software orfirmware. For example, navigation controller 15 can be loaded withsoftware that converts the signals received from the localizer 11 intodata representative of the position and orientation of the objects beingtracked. In some embodiments, the data associated with each surgery canbe stored in various type of memory within the robotic controller 90.After a minimum of, for example, 20 surgeries, the robotic controller 90can have some built-in artificial intelligence from the collections ofdata associated with prior surgeries to guide physicians for his or herfuture surgeries.

In some embodiments, prior to the start of a surgical procedure,additional data are loaded into the navigation controller 15. Based onthe position and orientation of the trackers 12 and the previouslyloaded data, navigation controller 15 determines the position of theoperating end of the surgical device 20 and the orientation of thesurgical device 20 relative to the tissue against which the operatingend is to be applied. The additional data may comprise calibration data,such as geometric data relating positions and/or orientations of thetrackers 12 or markers 80 thereof to the operating end of the surgicaldevice 20. This calibration data may also be determined pre-operativelyor intra-operatively, such as by using a calibration probe orcalibration divot on a tracker 12 of known geometry to determine aposition of the operating end of the surgical device 20, e.g., relativeto its own tracker or to a base tracker 12. The additional data mayinclude registration data, such as transformation data associating thetrackers 12 to the patient's anatomy or 3D models thereof. In someembodiments, navigation controller 15 forwards these data to the roboticcontroller 90 via a communication link (e.g., a wired or wirelesscommunication link). The robotic controller 90 can then use the data tocontrol the robotic arm 50.

In some embodiments, the navigation controller 15 also generates imagesignals representing the relative position and/or orientation of theoperation end of the surgical device 20 to the object (e.g., tissue,spine, disc) of interest. These image signals can be provided orcommunicated to the one or more displays 13B. Displays 13B, based onthese signals, can generate images that allow the surgeon and staff toview the relative position and/or orientation of the surgical device 20to the surgical site. The displays 13B as discussed above, may include atouch screen or other input/output devices that facilitate userinteraction (e.g., entry of commands, allow surgeon to visualize).

In the embodiment shown in FIGS. 1-3, using the navigation system 10,the position and/or orientation of the surgical device 20 can bedetermined. The determination can be based on tracking the location ofthe base 51 via a base tracker 12, calculating the position/orientationof the surgical device 20 based on joint encoder data associated withthe joints of the robotic arm 50, and/or a known geometric relationshipbetween the surgical device 20 and the robotic arm 50. As such, thelocalizer 11 and one or more trackers 12 enable the determination of theposition/orientation of the surgical device 20 and the patient'sanatomy. As a result, the navigation system 10 is provided with therelative relationship between the surgical device 20 and the patient'sanatomy. One such navigation system is described in more detail in U.S.Pat. No. 9,668,820 to Neubauer (BrainLabs), entitled “INTEGRATEDSURGICAL DEVICE COMBINING INSTRUMENT, TRACKING SYSTEM AND NAVIGATIONSYSTEM,” filed on Feb. 8, 2012, the content of which is herebyincorporated herein by reference in its entirety.

In a surgical operation, for certain surgical tasks, the user canmanually manipulate (e.g., move or cause the movement of) the roboticarm 50 to direct, guide, control, activate, or operate the surgicaldevice 20 to perform the surgical procedure on the patient. The surgicalprocedure may include, for example, removing tissue, cutting, drilling,implant installation, repairing, bone decorticating, guiding, or thelike. As the user manipulates the surgical device 20, the navigationsystem 10 tracks the position/orientation of the surgical device 20and/or the robotic arm 50 and provides haptic feedback (e.g., forcefeedback) to the user to limit the user's ability to move (or causemovement of) the surgical device 20 beyond one or more predefinedvirtual boundaries that are registered (or mapped) to the patient'sanatomy. The ability of robotic system 100 to keep the user'smanipulation of surgical device 20 within predefined virtual boundariesresults in highly accurate and repeatable procedures including, forexample, tissue removal, cutting, drilling, guiding, and implantinstallation.

In one embodiment, the robotic arm 50 operates in a passive manner andprovides haptic feedback when the surgeon attempts to move the surgicaldevice 20 beyond the virtual boundary. The haptic feedback is generatedby one or more actuators (e.g., joint motors) in the robotic arm 50 andtransmitted to the user via a joint transmission, such as a mechatronictransmission. When the robotic arm 50 is not providing haptic feedback,the robotic arm 50 is freely moveable by the user. In other embodiments,the robotic arm 50 is manipulated by the user in a similar manner, butthe robotic arm 50 operates in an active manner. For instance, the userapplies force to the surgical device 20, which is measured by aforce/torque sensor. The robotic arm 50 emulates the user's desiredmovement based on measurements from the force/torque sensor. In someembodiments, the robotic arm 50 operates autonomously and the user doesnot manually operate the surgical device 20.

FIG. 4 illustrates a partial view of an exemplary robotic arm 50 and anexemplary surgical device 20 coupled to the robotic arm 50. FIGS. 5A-5Cillustrate an exemplary surgical device 20 that is controllable by asurgical robotic system 100 to place a tissue-removal assembly 62 of thesurgical device 20 in different profiles or configurations. Surgicaldevice 20 can be, for example, a discectomy surgical device (e.g., thedevice shown in FIG. 4). As shown in FIG. 4, surgical device 20 can becoupled to the distal end 54 of the robotic arm 50 (FIG. 4 shows apartial robotic arm 50 of FIG. 2). More specifically, a robotic systemcoupler 55 is provided between the surgical device 20 and the distal end54 of the robotic arm 50.

In some embodiments, robotic system coupler 55 mechanically couples ahousing 32 of the surgical device 20 to the robotic arm 50. For example,the robotic system coupler 55 can be configured to mechanically attachsurgical device 20 interchangeably to any surgical device of choice usedin a surgery. For example, robotic system coupler 55 can be configuredto include detachable adapters for attaching different types of surgicaldevices. Robotic system coupler 55 may also include a universal adapterthat can vary in dimension and shape to fit with different types ofsurgical devices. Robotic system coupler 55 can include, for example, aflexible coupler and/or a rigid coupler to securely attach surgicaldevice 20 to robotic arm 50. Such a robotic system coupler 55 can beimplemented using, for example, a hinge-based coupling, a gear-basedcoupling, a fluid-based coupling, a magnetic-based coupling, ajoint-based coupling, a combination thereof, or the like. The surgicaldevice 20 can be a discectomy surgical device, an inserter for interbodyimplant, a screwdriver for pedicle screw, a bone decorticator, a duralrepair instrument, an ablation device, a drill, a saw, or the like. FIG.4 illustrates the surgical device 20 as a discectomy surgical device forremoving tissue from the disc space, inserting implants, drilling andinserting implants, removing boney tissue, repairing tissue, orproviding ablation procedure. It is appreciated that while FIG. 4illustrates one manner surgical device 20 that is attached, coupled, orintegrated with a surgical robotic system 100 (shown in FIGS. 1 and 3)through robotic arm 50, surgical device 20 can also be attached,coupled, or integrated with a surgical robotic system 100 in any otherdesired manners (e.g., by a hinge, screw, gear, joint, magnetic, quickrelease attachment, etc.).

In some embodiments, robotic system coupler 55 further electricallycouples, via a coupling interface 65 included in the housing 32 ofsurgical device 20, a drive system (not shown) of the surgical device 20to the surgical robotic system. For instance, robotic system coupler 55can include internal electrical wiring such that a power cable or wiringis extended from robotic arm 50 to the drive system of surgical device20 via the coupling interface 65. As such, surgical device 20 can beprovided with electrical power to operate the various components orsub-systems of surgical device 20 (e.g., to rotate shaft 61 and tooperate the tissue-removal assembly 62). In some embodiments, thecoupling interface 65 and the robotic system coupler 55 can both includecorresponding or matching power adapters, interfaces, sockets, or thelike, such that the power cables or wires can be easily connected fromrobotic arm 50 to surgical device 20. The coupling interface 65 isfurther described below.

In some embodiments, robotic system coupler 55 can furthercommunicatively couple the surgical device 20 to the surgical roboticsystem 100. For example, robotic system coupler 55 can include internalelectrical wiring such that one or more signal cables or wires areextended from robotic arm 50 to a drive system (not shown) of surgicaldevice 20 via the coupling interface 65. As such, surgical device 20 canbe provided with control signals to operate the various components orsub-systems of surgical device 20 (e.g., to rotate shaft 61 and tooperate the tissue-removal assembly 62). Moreover, surgical device 20can also provide feedback signals to the robotic controller 90 (shown inFIGS. 1 and 3) of the surgical robotic system by using the roboticsystem coupler 55. In some embodiments, the coupling interface 65 andthe robotic system coupler 55 can both include corresponding or matchingsignal adapters, interfaces, sockets, or the like, such that the signalcables or wires can be easily connected from robotic arm 50 to surgicaldevice 20. In some embodiments, surgical device 20 can wirelesslycommunicate with the robotic controller 90 (shown in FIGS. 1 and 3),e.g., using Bluetooth or Wi-Fi technologies.

In some embodiments, as shown in FIGS. 4 and 5A-5C, surgical device 20,which is a discectomy surgical device in these embodiments, includes ahousing 32, a drive system (not shown), a shaft 61, an outer tube 60,and a tissue-removal assembly 62. Housing 32 is capable of being coupledto the robotic arm 50 using robotic system coupler 55. As describedabove, robotic system coupler 55 can use any desired mechanical couplingmechanism to secure the surgical device 20 to robotic arm 50.Correspondingly, one or both housing 32 of surgical device 20 and distalend 54 of robotic arm may have matching mechanisms to facilitate suchcoupling. Such matching mechanisms may include mechanisms associatedwith, for example, a hinge-based, gear-based, fluid-based, screw-based,joint-based, magnetic-based, or a combination thereof coupling.

As described above, surgical device 20 can include a drive system (notshown in FIG. 4). In some embodiments, the drive system is partially orentirely mounted in the housing 32. The drive system can be electricallyand communicatively coupled with, for example, robotic controller 90 orsurgical robotic system 100. A drive system can be controlled by roboticcontroller 90 to operate surgical device 20, such as a discectomysurgical device and/or other accessories of device 20. The drive systemmay include a motor with variable speed or one constant speed. Therobotic controller 90 can transmit signals to the drive system tooperate, for example, the shaft 61 and the tissue-removal assembly 62.As discussed in more detail below, tissue-removal assembly 62 mayinclude a first cutting member 37 and a second cutting member 36. Thetwo cutting members can be controlled independently or in coordinationwith each other by the drive system using the signals transmitted ormechanically controlled from the robotic controller 90. In someembodiments, the housing 32 can include one or more control componentsin addition to the drive system. The additional control components(e.g., a separate controller) can be configured to control thetissue-removal assembly 62 and other optional features of the surgicaldevice 20.

As described above, robotic system coupler 55 can electrically andcommunicatively couple the surgical device 20 to the surgical roboticsystem, via the coupling interface 65. The coupling interface 65 may beused to bring power source from the robotic arm 50 to the surgicaldevice 20, including but not limited to on and off states of the motorof the surgical device 20, varying motor speed of the motor of thesurgical device 20, and/or controlling the steerability of the steeringmechanism 38 (shown in FIG. 6). In some embodiments, the couplinginterface 65 can include one or more electrical contacts to bring adirect current (DC) power source between 5 volts and 30 volts to powerthe motor in the housing 32 of the surgical device 20. In someembodiments, the coupling interface 65 may also change the motor speedand/or movement direction of the tissue-removal assembly 62. In someembodiments, as described above, the coupling interface 65 may alsoprovide the mechanical securement to couple any surgical device 20 tothe distal end 54 of the robotic arm 50.

In some embodiments, the surgical device 20 can be a discectomy surgicaldevice 30, which includes a shaft 61, an outer tube 60, a collectionchamber 34, and a tissue-removal assembly 62. Shaft 61 is rotatablycoupled to the drive system at a first end. Shaft 61 is sometimes alsoreferred to as an inner shaft enclosed at least partially within outertube 60 in some embodiments, shaft 61 can include an elongated memberwith screw threads configured to transport removed tissues. Asillustrated in FIGS. 4 and 5A-5C, screw threads 35 can form an integralpart of shaft 61 (e.g., manufactured together). Screw threads 35 can be,for example, auger or Archimedes' screw for transporting tissues removedfrom the surgical site to the collection chamber 34. As will bedescribed in more detail below, tissues can be removed by tissue-removalassembly 62, which can include a first cutting member 37 and a secondcutting member 36. For example, second cutting member 36 can include oneor more rotatable cutting tips for grinding up tissue and for removingtissues from the surgical site. And first cutting member 37 can includea plurality of rotatable blades for cutting tissue within narrow discspace. The first cutting member 37 can be coupled to the second end ofthe elongated member of the shaft 61. Thus, the drive system can becontrolled (e.g., by the robotic controller 90) to operate shaft 61,which in turn rotates first cutting member 37 of the tissue-removalassembly 62.

FIGS. 5A-5C depict one embodiment of a surgical device 20 in differentprofiles or configurations. As illustrated, the surgical device 20 canbe a discectomy surgical device 30, which is controllable by the roboticcontroller 90 of the surgical robotic system 100 to place atissue-removal assembly 62 of the surgical device 20 in differentprofiles. In this embodiment, surgical device 20 includes an outer tube60 coupled to the housing 32 at a first end. The outer tube 60 enclosesat least a part of the shaft 61 (e.g., cable) that is attached to atissue-removal assembly 62. As described above, shaft 61 is coupled tothe drive system (e.g., a motor) and is thus rotatable. The outer tube60 may be static and may not be rotatable by itself. In someembodiments, the surgical device 20 may not have an outer tube and theshaft 61 may be inserted into a lumen of a cannula or other accessdevice. In some embodiments, the outer tube 60 may enclose a part ofshaft 61 or the entire shaft 61. The outer tube 60 can also have asecond end. The second end can have an opening such that removed tissuesor fluids can be collected through the opening and transported insideouter tube 60 back to a collection chamber 34. In some embodiments, thesecond end of outer tube 60 may also have a sharp cutting edge tofurther improve the cutting capability of surgical device 20, which willbe described in more detail below.

FIGS. 4 and 5A-5C also illustrate the tissue-removal assembly 62,examples of which are described in greater detail below. Tissue-removalassembly 62 includes first cutting member 37 and second cutting member36. Using one or both of the two cutting members, tissue-removalassembly 62 can be configured to decorticate, pulverize, cut, chop,grind, burr, debride, debulk, emulsify, disrupt or otherwise removetissue more efficiently and precisely. One or both of the cuttingmembers of tissue-removal assembly can be rotated at constant or variousspeeds. Emulsification includes, for example, forming a suspension oftissue particles in a medium, which may be the existing liquid at thetarget site, liquid added through the discectomy surgical device, and/orliquid generated by the debulking of the tissue. The tissue removal mayencompass removing blood as well. In some embodiments, surgical device20 can be a discectomy surgical device, which can further include, butare not limited to, a motor configured to rotate or move thetissue-removal assembly 62, a power source or power interface, a motorcontroller, a tissue transport assembly, an energy delivery orcryotherapy assembly, a therapeutic agent delivery assembly, a lightsource, and/or one or more fluid seals. A tissue transport assembly mayinclude, for example, a suction assembly and/or a mechanical aspirationassembly. One or more of these components may act through the outer tube60 to manipulate the tissue-removal assembly 62 and/or other componentslocated distal to the housing 32, or from the housing 32 directly.

In some embodiments as illustrated in FIGS. 4 and 5A-5C, the surgicaldevice 20 can be a discectomy surgical device 30, which furthercomprises a tissue collection chamber 34 mounted with the housing 32.The collection chamber 34 can be in fluid connection with thetissue-removal assembly 62, for example, through a lumen of the shaft61. A lumen can be a hollow space, a slot, a tube, or a dedicatedchannel for passing materials such as tissues, fluids, cables, wires, orthe like. In some embodiments, collection chamber 34 collects tissueand/or fluid pulverized by the tissue-removal assembly 62, andtransports through the lumen by the rotating drive shaft 61 and screwthreads 35 (e.g., auger) from a disc space 110 (shown in FIG. 6) to thecollection chamber 34. In some embodiments, the collection chamber 34include one or more collection ports 45. Collection ports 45 can includeone or more removable caps or plugs. The collection pons 45 enabletransporting the removed tissues or fluids out of collection chamber 34via, for example, one or more tubes or pipes coupled to the collectionchamber 34 at the collection ports 45.

In some embodiments, the surgical device 20 can be controlled by therobotic arm 50. As a result, the surgical device 20 can be used forsurgical and/or percutaneous spinal procedures, e.g., interbody fusionprocedures, minimally invasive or open discectomy, minimally invasive oropen laminectomy, or the like. Such a surgical device 20 is depicted inFIGS. 4, 5A-5C, and 6 as a discectomy surgical device. The surgicaldevice 20 may comprise a proximal housing 32 and a distal tissue-removalassembly 62 connected to the housing 32 by the outer tube 60 with alongitudinal lumen therethrough. In some embodiments, the housing 32 canalso be shaped (e.g., as illustrated in FIGS. 4 and 5A-5C) to have afirst end having a smaller dimension and a second end having a largerdimension. Such a shape can enable an easy coupling to robotic arm 55and/or an easy manual handling by a user (e.g., the user can easilyoperate the surgical device 20 by holding the smaller end of housing32). Optionally, the outer tube 60 may include an endoscope port orlumen for visualizing tissue during the procedure. In some variations,the outer tube 60 may be straight, or may have one or more pre-shapedcurves or angles, or may be steerable with the action from the roboticarm 50. As described above, the housing 32 may include a couplinginterface 65 that has a quick attachment and detachment mechanisms byusers. For example, the housing 32 includes an electrical contactswithin the coupling interface 65 that may be used to bring power sourceto actuate/operate the components (e.g., the first cutting member 37 andthe second cutting member 36) of the tissue-removal assembly 62, as wellas a mechanism for navigating the tissue-removal assembly 62. In somevariations, the navigation and movement of the surgical device 20 may beprecisely controlled by the robotic arm 50.

As described above, in some embodiments, the surgical device 20 can be adiscectomy surgical device 30, which may also include a collectionchamber 34. Collection chamber 34 can be transparent. For example, asdepicted in FIG. 6, the housing 32 may be mounted with, or include, acollection chamber 34. Collection chamber 34 may be in fluid or tissueconnection with the tissue-removal assembly 62 through a lumen betweenrotating shaft 61 and outer tube 60. Tissue that is removed (e.g.,decorticated, pulverized, cut, dissected, etc.) by the tissue-removalassembly 62 and/or fluids may be transported by a tissue transportassembly (e.g., shaft 61 and lumen inside outer tube 60) through therotating shaft 61 to the collection chamber 34. One embodiment of suchtransportation has been described above. In some embodiments, a vacuumsource may be used to draw tissue and/or fluid from the target tissuesite to the collection chamber 34. Some tissue-removal devices may havea plurality of collection chambers, where some of the collectionchambers may be used as a fluid reservoir for tissue infusion, and someof the collection chambers may be used to store tissue samples removedby the tissue-removal assembly 62. The one or more collection chambersmay be located at a distal or proximal portion of the housing 32, asillustrated in FIG. 6, or may be located within the housing 32. Similarto those described above, the one or more collection chambers 34 mayinclude one or more collection ports 45 with a removable cap or plug.Optionally, a portion of the collection chamber 34 may be configured asa magnifying lens which may be used to visually inspect any collectedsamples. In some variations, the removable plug or cap of the collectionport 45 may itself be a magnifying lens. The collection chamber 34 maybe made of an optically transparent material, such as polycarbonate,acrylic and the like.

One example of a distal portion of the outer tube 60, the shaft 61, andthe tissue-removal assembly 62 of a surgical device (e.g., discectomysurgical device) is depicted in FIG. 8. In some embodiments, the endportion (e.g., the distal portion) of the outer tube 60 includes a tip63. The tip 63 is disposed closer to the tissue-removal assembly 62 thanto housing 32 (shown in FIG. 4). In some variations, the distal portionof the outer tube 60 may comprise an insulating polymer sheath or tubethat may prevent heat generated by the rotating mechanisms within theouter tube 60 to the outer portion of the outer tube 60, as such heatmay thermally injure tissue. The outer portion of the outer tube 60 maybe in contact with the patient's tissue. The insulating sheath may belocated at regions of the outer tube 60 that may have the greatestlikelihood of contacting tissue.

In some embodiments, the tip 63 of outer tube 60 includes a cutting edge64 that improves the capability for further breaking-up or cuttingtissue removed by the tissue-removal assembly 62. In some embodiments,as illustrated in FIG. 8, the end portion of the outer tube 60 havingthe tip 63 has a cross-sectional dimension that is larger than that ofother portions of the outer tube 60. For example, this end portion maygradually increase in cross-section dimension from the other portions ofthe outer tube 60 to the tip 63. This end portion can have, for example,a beveled shape as illustrated in FIG. 8. Such an end portion with asharp cutting edge 64 can further improve the cutting efficiency andprecision of the surgical device 20 (e.g., a discectomy surgicaldevice).

In some embodiments, the tip 63 may be welded, soldered, brazed, glued,and/or crimped to the distal portion of outer tube 60. Alternatively,the tip 63 may be integrally formed with the distal portion of the outertube 60. The tip 63 may be made of stainless steel (e.g., 440C stainlesssteel, 440F SE stainless steel, or 304 stainless steel), and may be heattreated to RC 55-60, with a bright finish that may be passivated perASTM-A967 standards. The outer tube may also be made of a variety ofmaterials, such as other metallic materials (e.g., nickel titaniumalloys, cobalt chromium, tungsten, etc.) and/or polymeric materials(e.g., PEEK, polyimide, polyaramides, polyethylene, etc.), asappropriate.

With reference to FIG. 8, the tissue-removal assembly 62 may extenddistally from the outer tube 60 (e.g., from the tip 63 of outer tube60). The tissue-removal assembly 62 may be any of the tissue-removalassemblies described above, as well as any of the tissue-removalassemblies described below. As shown in FIG. 8. The tissue-removalassembly 62 can include one or more extendable elements 66 (e.g., alooped extendable element), one or more support elements 67 (e.g., alooped support element), a first cutting member 37, and a second cuttingmember 36. In some embodiments, the second cutting member 36 can jointhe looped portions of the one or more extendable elements 66 and theone or more support elements 67. In this arrangement, adjusting thelength and position of the one or more extendable elements 66 can changeor adjust the position and orientation of the second cutting member 36and the one or more support elements 67. In other variations, the one ormore support elements 67 may be independently adjustable from the lengthand position of the one or more extendable elements 66. There may be anynumber of extendable and support elements, and the extendable and/orsupport elements may or may not be looped through the cutting element.For example, an extendable element 66 may not be looped through thesecond cutting member 36 (e.g., may be instead attached to the secondcutting member as a single strand), while the one or more supportelements 67 are looped through the second cutting member 36. Theextendable elements 66 and/or support elements 67 may be slidably orfixedly coupled to the second cutting member 36.

The tissue-removal assembly 62 can also include a first cutting member37. As shown in FIG. 8, in some embodiments, first cutting member 37includes an elongated member (e.g., a column-shaped member) having aplurality of rotatable blades 37A, 37B, 37C, etc. The rotatable bladescan be formed along the longitudinal direction of the elongated member.The rotatable blades can form an integral part of the elongated memberof first cutting member 37 or be mounted separately to the elongatedmember of first cutting member 37. Therefore, the rotatable blades canrotate with first cutting member 37 in a synchronized manner (e.g., samespeed) or asynchronized manner (e.g., different speeds). The rotation ofthe first cutting member 37 and/or its rotatable blades can becontrolled by the drive system and/or any other controllers of surgicaldevice 20, which can in turn be controlled by the robotic controller 90of the robotic system. In some embodiments as shown in FIG. 8, therotatable blades (e.g., 37A-C, etc.) of the first cutting member 37, thesecond cutting member 36, and the auger 35 along the shaft 61 canprovide a vortex effect of flow-control to bring tissue or fluid fromthe surgical site to the collection chamber 34. While FIG. 8 illustratesthe rotatable blades as having straight lines edges along thelongitudinal direction of the first cutting member 37, it is appreciatedthat curved edges can also be implemented as desired.

Moreover, in some embodiments, the plurality of rotatable blades offirst cutting member 37 can form a cross-section having a polygon shape.In the example shown in FIG. 8, the cross-section of first cuttingmember 37 forms a star-shaped polygon. The star-shaped polygon has eightprotrusions or angles corresponding to the eight rotatable blades. Eachof the eight protrusions of the cross-section forms an about 90-degreeangle. As described above, the rotatable blades having such astar-shaped polygon cross-section can improve the tissue cuttingefficiency and precision, thereby enhancing the overall efficiency ofthe surgical device 20. Further, when the surgical device 20 iscontrolled by a robotic system, the efficiency of the surgery can begreatly improved. For example, instead of hundreds of times of manualrepeating of the insertion and cutting operation using a surgical toolby a human user, a robotically controlled surgical device disclosed inthis disclosure may only require a one-time insertion/cutting or agreatly-reduced number of times of repeated insertion and cutting. Thecutting can also be precisely controlled by the robotic system byoperating the first cutting member 37 and second cutting member 36together to achieve a better and more efficient result.

FIG. 8 illustrates the star-shaped polygon of the first cutting member37 as having eight rotatable blades corresponding to eight protrusionsor angles on the cross-section FIG. 9 illustrates a plurality ofexemplary cross-sectional shapes of possible cutting members 137A-Falternative to first cutting member 37. As shown in FIG. 9, similar tofirst cutting member 37, the cutting members 137A-F can also have aplurality of rotatable blades formed along the longitudinal direction ofthe cutting members. The cross-sectional shapes of the cutting members137A-F can have one of five-, six-, seven-, eight-, nine-, or ten-angleprotrusions along the longitudinal direction of the cutting members137A-F, respectively. In some embodiments of the surgical device 20, theeven-numbered protrusions (e.g., six, eight, ten) are preferred thanodd-numbered protrusions (e.g., five, seven, nine). Similar to the abovedescribed first cutting member 37, cutting members 137A-F cancorrespondingly have five-, six-, seven-, eight-, nine-, orten-rotatable blades (straight or curved along the longitudinaldirection) for improving the cutting efficiency of the surgical device.In some embodiments, the first cutting member 37 can have across-sectional shape as a square or a rectangular with sharp cuttingedge.

In some embodiments, the cross-sectional shape of the first cuttingmember 37 may have any polygon shapes other than those described abovein FIGS. 8 and 9. The polygon shape can be symmetrical or asymmetrical.A symmetrical polygon shape can have, for example, reflectionalsymmetry, linear symmetry, mirror-image symmetry, bilateral symmetry,point symmetry, rotational symmetry, etc. The polygon shape can alsohave asymmetry, e.g., asymmetry along any axis or a center point.

With reference back to FIG. 8, in some embodiments, the loops ofextendable elements 66 and the support elements 67 can extend from therotatable blades or cutting blades of first cutting member 37. Forexample, the extendable elements 66 and support elements 67 can both beattached to different portions of first cutting element 37 withoutinterfering the operation of the rotatable blades. In some embodiments,the tissue-removal assembly 62 can further include a reinforcing ring 68located proximally to the first end of first cutting member 37. Thereinforcing ring 68 is configured to retain a proximal portion of theone or more support elements 67. Optionally, shaft 61 (e.g., a tissuetransport assembly) may be integrated with the tissue-removal assembly62 as described above and further described below.

With reference back to FIGS. 5A-5C, in some embodiments, thetissue-removal assembly 62 can have different profiles orconfigurations. The one or more support elements 67 and one or moreextendable elements 66 are controllable by, for example, roboticcontroller 90 of the surgical robotic system 100 to configure thetissue-removal assembly 62 to a plurality of different profiles. FIG. 5Aillustrates a collapsed profile or configuration of the tissue-removalassembly 62. FIG. 5B illustrates a partially-expanded profile orconfiguration of the tissue-removal assembly 62. FIG. 5C illustrates afully-expanded profile or configuration (also depicted in FIG. 8) of thetissue-removal assembly 62. In the fully-expanded configuration, thesecond cutting member 36 may be displaced or moved away from the firstcutting member 37, as illustrated in the side view of FIG. 8. The shapeand volume of the tissue region that is removed is at least partiallydetermined by the amount of displacement or the distance of the secondcutting member 36 from the first cutting member 37. For example, in afully-expanded profile or configuration (FIG. 5C), the shape and volumeof the tissue removal region may be substantially larger than those of acollapsed profile (FIG. 5A) or a partially-expanded profile (FIG. 5B).Further in the embodiments of FIGS. 5A-5C, the second cutting member 36is configured to be offset from the longitudinal axis of the outer tube60 and shaft 61. This offset can generate a vortex effect of flowcontrol as the second cutting member 36 rotates. As the distance of thesecond cutting member 36 is displaced further away from the firstcutting member 37 as shown in FIGS. 5B and 5C, the vortex effect mayincrease or become greater at or around the region of tissue-removalassembly 62. In addition to the vortex effect, the configuration ofscrews threads 35 (e.g. auger) on the shaft 61 and the tip 63 of theouter tube 60 can generate a suction effect to remove the tissue and/orfluid out of the surgical site. The vortex effect and the suction effectcan be generated simultaneously or in coordination with each other tofurther enhance the efficiency of removing the tissue and/or fluid.

The location of the second cutting member 36 in the expandedconfiguration (partial or fully) of the tissue-removal assembly 62 maybe determined by the length and compliance of the one or more supportelements 67 and the one or more extendable elements 66, the attachmentlocations of the one or more support elements 67 on the first cuttingmember 37, and the coupling locations of the one or more supportelements 67 and one or more extendable element 66 on the second cuttingmember 36. In some embodiments, the different profiles or configurationsof the tissue-removal assembly 62 can be controlled by roboticcontroller 90 of surgical robotic system 100. For example, the roboticcontroller 90 can transmit control signals to the drive system and/orother controllers included in the surgical device 20. The drive systemand/or other controllers can in turn dynamically adjust or change one ormore of the length, compliance, attachment locations, coupling locationsassociated with the support elements and/or the extendable elements. Asa result, the robotic controller 90 can control the shape and volume ofthe tissue region that is removed.

In some embodiments, the one or more support elements 67 and the one ormore extendable elements 66 may be metallic or polymeric multifilamentcables. A polymeric cable such as Kevlar string or cord may be adhesivebonded, e.g., using epoxy, to the components described above. Apolymeric cable may be optionally reinforced by a metallic and/orpolymeric ring. A metallic support element may be attached to the firstcutting member 37 and/or the shaft 61 (e.g., a tissue transportassembly) by soldering, welding, etc. A polymeric support element may beattached to the first cutting member 37 and/or shaft 61 by gluing or anyother suitable attachment method. The attachment of a looped supportelement 67 to the first cutting member 37 and/or the shaft 61 may befurther secured and reinforced by the reinforcement ring 68. Forexample, as shown in FIG. 8, the proximal portion of the leading segmentof a looped support element 67 may be attached at a first attachmentsite 69, and the proximal portion of the trailing segment 71 of the loopsupport element 67 may be attached at a second attachment site (oppositeof site 69 so not shown). The second attachment site is directlyopposite with respect to the first attachment site. In some embodiments,the one or more support elements 67 and the one or more extendableelements 66 may be made of Kevlar string or cord encapsulated in apolyimide tubing to provide an enhanced or improved pushability andtractability feature while maintaining the flexibility and its kinkresistant benefit.

As described previously, a looped support element 67 and a loopedextendable element 66 may be joined at the second cutting member 36 bypassing through a lumen 72 of the second cutting member 36. For example,the portion of the looped support element 67 or the looped extendableelement 66 can be passed through the lumen of the second cutting member36 as illustrated in FIG. 8. In one variation, the support elements 67and/or extendable elements 66 may be bonded, glued, soldered, welded,etc. to the second cutting member 36, according to the desired level ofmovement through and/or along the second cutting member 36. The supportelements 67 and/or the extendable elements 66 may be attached to thesecond cutting member 36 such that they may be restricted from slidingalong the plane of the lumen 72, and/or may be restricted from slidingtransversely through the plane of the lumen. For example, support and/orsliding elements retained in a cutting lumen lobe may be restricted frommoving within the plane of the lumen, and soldering the support and/orsliding elements may restrict both in-plane and transverse-planemovement. In some embodiments, second cutting member 36 may be made ofthe strength-enhanced metallic material such as carbon steel, stainlesssteel like 440C or alike, tungsten carbide, titanium, steel-iron-nickelalloy, titanium aluminide, inconel, chromium, etc.

In some embodiments, the position of the second cutting member 36 andthe angle of the one or more support segments 67 may be determined byadjusting the length of the one or more extendable elements 66 that isexternal to the second cutting member 37. In some embodiments, a loopedsupport element 67 may be configured to stabilize and maintain thealignment of the cutting element 36 with respect to the first cuttingmember 37.

With reference back to FIG. 5A, in the collapsed profile orconfiguration of the tissue-removal assembly 62, the one or moreextendable elements 66 may be retracted. As a result, the second cuttingmember 36 can be positioned relatively closer to the first cuttingmember 37, such that the tissue-removal assembly 62 has a low profile(e.g., a profile that has a lateral dimension that is substantiallysimilar to the dimension of the cross-sectional area of the firstcutting member 37). In some variations, second cutting member 36 may beroughly or substantially aligned along the central longitudinal axis ofthe first cutting member 37 of the tissue-removal assembly 62 when theone or more extendable element 66 are retracted. Retraction of the oneor more extendable elements 66 and the second cutting member 36 towardthe first cutting member 37 may cause the one or more support elements67 to collapse towards the outer surface of the first cutting member 37.As a result, a substantial length of the one or more support elements 67overlaps with the length of the longitudinal direction of the firstcutting member 37. The narrowed profile in the collapsed configurationimproves the capability of the tissue-removal assembly 62 to advancethrough small anatomical regions and within cracks and creases intissue. In addition, the narrowed profile enables the rotatable bladesof first cutting member 37 to perform a critical function to decorticatethe endplate or tissue even in tight and small space.

As described above, pre-operative imaging and/or intra-operative imagingmay be employed to visualize the patient's anatomy that requirestreatment-such as the patient's spine. The surgeon plans where to placethe surgical device 20 (e.g., a discectomy surgical device) or interbodycage within the disc space or pedicle screws with respect to the imagesand/or with respect to a 3D model created from the images. Planningincludes determining a location of each interbody cage with respect tothe particular disc space, and/or determining a location of each pediclescrew with respect to the particular pedicle bone, in which they arebeing targeted (e.g., by identifying the desired location in the imagesand/or the 3D model). Planning may also include creating or positioninga separate 3D model of the disc space with respect to the 3D model ofthe patient's anatomy. Once the plan is determined, then the plan istransferred to a surgical robotic system (e.g., system 100 shown inFIGS. 1 and 3) for execution.

With reference back to FIG. 3, in some embodiments, the surgical roboticsystem 100 may be used in the operating room or surgery center or labwith an imaging device 70 (e.g., a fluoroscopy C-arm as shown in FIG. 3)to take the intra-operative images of the patient's anatomy in additionto, or alternatively to, any pre-operative images, e.g., X-rays, CTscans, or MRI images taken before surgery. The intra-operative imagesfrom the imaging device 70 can facilitate the surgical robotic system100 to determine the actual position/orientation of the surgical device20, the position/orientation of the interbody cage inserter (not shown),and/or the position/orientation of the screw driver for pedicle screw(not shown) relative to the desired location of the disc space orpedicle location for the patient's spine.

As described above and shown in FIG. 3, separate tracking devices 12 canbe employed on each disc space to separately track each disc space andthe corresponding position of the surgical device 20, interbody cageinserter, and/or screw driver, a drill relative to the separate discspace or pedicle when placing the interbody cage implant or otherimplants into the disc space. For example, the imaging device 70 mayproduce DICOM (Digital Imaging and Communication in Medicine) files forthe surgical robotic system 100. After the DICOM files are processed bythe surgical robotic system 100, the surgical robotic system 100 can beself-sufficient to guide or perform the entire surgery using, forexample, the surgical device 20. The surgery can be discectomy at theexact location, interbody implant at the specific position, pediclescrew trajectory, and/or any other desired operations or procedures.Files in the DICOM format are most likely saved with either a DCM orDCM30 (DICOM 3.0) file extension, but some may not have an extension atall. DICOM is both a communications protocol and a file format, whichmeans it can store medical information, such as ultrasound and MRIimages, along with a patient's information, all in one file. The formatenables all the data to be saved together and provides the ability andcompatibility to transfer said information between any devices orsystems, such as the surgical robotic system 100, that support the DICOMformat.

In some embodiments, the surgical robotic system 100 evaluates thedesired location of the disc space, the interbody cage implant, orpedicle screw location. Based on the evaluation, the surgical roboticsystem 100 generates or defines virtual boundaries (e.g., hapticobjects), predefined tool paths, and/or other autonomous movementinstructions. These virtual boundaries, tool paths, and/or movementinstructions correspond to the desired location of the interbody cageimplant to control movement of the robotic arm 50. Therefore, thesurgical device 20 (e.g., a discectomy surgical device), the interbodycage inserter, and/or the screwdriver for the pedicle screw, can beintegrated together as one device or combined together. The integratedor combined device can be controlled in a manner to perform thediscectomy tissue removal and place the interbody cage implant accordingto the users plan. The integrated or combined device can also becontrolled to provide the correct trajectory for the pedicle screws. Forexample, the integrated or combined devices can be controlled to ensureduring the surgical procedure that a trajectory of the surgical device20 is aligned with the desired location of the interbody cage implant(e.g., aligning the trajectory of a discectomy surgical tool and theinterbody cage inserter with the desired location of the interbody cageimplant).

With reference to FIG. 6, while the surgical robotic system 100 holdsthe surgical device 20 on the desired location and trajectory, the usermay manually manipulate the surgical device 20 to move (or causemovement of) the surgical device 20, the interbody cage inserter, and/orthe screw driver along the line haptic object (e.g., the object thatforms a virtual boundary) toward the disc space 110 to remove the tissuefrom the disc space 110. In some cases, such as when using a passiverobotic arm 50, the surgical robotic system 100 constrains the user'smovement of the surgical device 20 to stay along the desired trajectoryby providing haptic feedback to the user, if the user attempts to movethe surgical device 20 in a manner that deviates from the line hapticobject and the desired trajectory. If the user desires to return therobotic arm 50 to a free mode, for unconstrained movement of thesurgical device 20, the user can pull the surgical device 20 back alongthe line haptic object, away from the patient.

With reference back to FIG. 3, a 3D sensor, an ultrasound transducer(not shown), and/or a portable MRI imager (not shown) can also bemounted on the robotic arm 50, the localizer 11, and/or the back of thepatient's skin to generate real-time images of the patient's anatomy andprogress of the surgical procedure. The intra-operative images can beused to determine that the tissue removal and interbody cage follow theplanned desired trajectory. The intra-operative images can also be usedto determine if the surgical device 20, the interbody cage inserter, theinterbody cage implant, the screw driver, and/or the pedicle screw isgetting close to any critical structures including a nerve and medial orcortical boundary.

FIG. 7 are schematic views of a lumbar region of a spine 120. Thevertebral canal 124 is formed by a plurality of vertebrae 121, 122, and123. The vertebrae 121, 122, and 123 include vertebral body 127anteriorly and vertebral arch 128 posteriorly. The spinal cord 129 issituated within the vertebral canal 124. Spinal nerves 130 branch fromthe spinal cord 129 bilaterally and exit the vertebral canal 124 throughintervertebral foramina 126 that are formed by the adjacent vertebra104, 106 and 108. The intervertebral foramina 131 are typically borderedby the inferior surface of the pedicles 132, a portion of the vertebralbodies 127, the inferior articular processes 133, and the superiorarticular processes 134 of the adjacent vertebrae. Also projecting fromthe vertebral arch 128 are the transverse processes 126 and theposterior spinous processes 125 of the vertebrae 121, 122, and 123.Located between the vertebral bodies 127, 135, and 136 are the vertebraldiscs 140. The vertebral discs (or discs) 140 are fibrocartilages lyingbetween adjacent surfaces of the vertebrae 127, 135, and 136. They forma fibrocartilaginous joint between the vertebral bodies, linking themtogether.

Collectively, the discs 140 make up one third to one quarter of thetotal spinal column's length, forming an interpose between adjacentvertebrae from the axis (C1) to the sacrum. There are about 23 discs inthe spine; 6 cervical, 12 thoracic, and 5 in the lumbar region. Theintervertebral discs are approximately 7-10 mm thick and 4 cm indiameter (anterior-posterior plane) in the lumbar region of the spine.It consists of a thick outer ring of fibrous cartilage called theannulus 150, which surrounds an inner gel-like center or more gelatinouscore known as the nucleus pulposus 110. The nucleus pulposus issandwiched inferiorly and superiorly by cartilage endplates 160. Boththe annulus 150 and the nucleus pulposus 110 are elastic collagenousstructures which, over time, may decrease in elasticity and cause thenucleus pulposus to bulge out at a weakened region of the annulusfibrosus 150, and even extrude through the annulus fibrosus 150. In FIG.4 and FIG. 7, for example, once the surgical robotic system 100 (shownin FIG. 3) has been configured for surgeon to conduct a procedure, asurgical device 20 can be inserted into the disc space 110 slowlycontrolled by the robotic system 100 via the robotic arm 50. Thesurgical device 20 is then actuated by the surgeon and/or the roboticsystem 100 to break up and remove the extruded material. In oneembodiment, if the disc space is collapsed or narrow, the surgicaldevice 20 is then actuated to spin the first cutting member 37 todecorticate the endplate 160. In some embodiments, the surgical device20 may be further inserted distally into the disc 110. Additional tissuewith the disc 110 may then be removed. Although contralateral access ofthe herniated disc is depicted in FIG. 6 by steering the steeringmechanism 38, ipsilateral access may also be used to remove tissue. Inyet other embodiments that can be developed to couple to the robotic arm50, other devices used to remove disc tissue for discectomy ornucleotomy may include lasers, discectomes, trephines, burrs, rongeurs,rasps, curettes and cutting forceps. Many of these devices have asubstantial cross-sectional size, and when inserted into a disc, createan insertion channel which substantially compromises the integrity ofthe endplate 160 within the disc space 110.

It should be appreciated that the systems and methods described hereincan be employed to remove tissue from the disc space and to placeinterbody cage implant, cutting, drilling or place other implants into apatient. So, even though tissue removal and interbody cage implantinsertion are referenced throughout as one example, the same systems andmethods described herein could be utilized for treating any anatomy ofthe patient and/or for placing any implants into the patient, e.g., inthe spine, hip, knee, shoulder, etc. For instance, the robotic arm 50may also be used to drill a pilot hole on the pedicle bone, and to placea pedicle screw for a spine implant, to place rods, or to place othercomponents, and can be used for cutting, and drilling or otherprocedures. Different end effectors could also be attached to therobotic arm 50 and the robotic system coupler 55 for other procedures.In some cases, the end effector may also have an articulating arm tofacilitate other implant insertion, i.e., placing the implant in adesired position. The articulating arm of the end effector can simply bea miniature version of the robotic arm 50 controlled in the same mannerto place the implant or can be another mechanism controlled to positionthe implant. The navigation system 10 may include an optical navigationsystem with optical-based trackers, but can additionally oralternatively employ other modalities, such as ultrasound navigationsystems that track objects via ultrasound, radio frequency navigationsystems that track objects via RF energy, and/or electromagneticnavigation systems that track objects via electromagnetic signals. Othertypes of navigation systems are also contemplated.

Several embodiments have been discussed in the foregoing description.However, the embodiments discussed herein are not intended to beexhaustive or limit the invention to any particular form. Theterminology which has been used is intended to be in the nature of wordsof description rather than of limitation. Many modifications andvariations are possible in light of the above teachings and theinvention may be practiced otherwise than as specifically described.

The previous description is provided to enable any person skilled in theart to practice the various aspects described herein. Variousmodifications to these aspects will be readily apparent to those skilledin the art, and the generic principles defined herein may be applied toother aspects. Thus, the claims are not intended to be limited to theaspects shown herein, but is to be accorded the full scope consistentwith the language claims, wherein reference to an element in thesingular is not intended to mean “one and only one” unless specificallyso stated, but rather “one or more.” The word “exemplary” is used hereinto mean “serving as an example, instance, or illustration.” Any aspectdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects. Unless specifically statedotherwise, the term “some” refers to one or more. Combinations such as“at least one of A, B, or C,” “one or more of A, B, or C,” “at least oneof A, B, and C,” “one or more of A B, and C,” and “A, B, C, or anycombination thereof” include any combination of A, B, and/or C, and mayinclude multiples of A, multiples of B, or multiples of C. Specifically,combinations such as “at least one of A, B, or C,” “one or more of A, B,or C,” “at least one of A, B, and C,” “one or more of A, B, and C,” and“A, B, C, or any combination thereof” may be A only, B only, C only, Aand B. A and C. B and C, or A and B and C, where any such combinationsmay contain one or more member or members of A, B, or C. All structuraland functional equivalents to the elements of the various aspectsdescribed throughout this disclosure that are known or later come to beknown to those of ordinary skill in the art are expressly incorporatedherein by reference and are intended to be encompassed by the claims.Moreover, nothing disclosed herein is intended to be dedicated to thepublic regardless of whether such disclosure is explicitly recited inthe claims. The words “module,” “mechanism,” “element,” “device,” andthe like may not be a substitute for the word “means.” As such, no claimelement is to be construed under 35 U.S.C. § 112(f) unless the elementis expressly recited using the phrase “means for.”

What is claimed is:
 1. A surgical device controllable by a surgicalrobotic system, comprising: a housing capable of being coupled to thesurgical robotic system; a drive system at least partially mounted inthe housing; a shaft rotatably coupled to the drive system at a firstend of the shaft; a tissue-removal assembly coupled to a second end ofthe shaft, wherein the tissue-removal assembly comprises: a firstcutting member having a plurality of rotatable blades, wherein the firstcutting member is coupled to the second end of the shaft, a secondcutting member, one or more support elements slidably or fixedly coupledto the second cutting member, wherein the one or more support elementscomprise a looped support element inserted through an inner portion ofthe second cutting member, and one or more extendable elements slidablyor fixedly coupled to the second cutting member, wherein the one or moresupport elements and the extendable elements are extendable andretractable to adjust the position of the second cutting member withrespect to the first cutting member.
 2. The surgical device of claim 1,further comprising a robotic system coupler that: mechanically couplesthe housing of the surgical device to a robotic arm of the surgicalrobotic system; and electrically and communicatively couples the drivesystem of the surgical device to the surgical robotic system.
 3. Thesurgical device of claim 2, wherein the robotic system coupler comprisesone or more components configured to couple the housing of the surgicaldevice to the robotic arm of the surgical robotic system using at leastone of: a hinge-based coupling; a gear-based coupling; a fluid-basedcoupling; a magnetic-based coupling; and a joint-based coupling.
 4. Thesurgical device of claim 1, further comprising a collection chambermounted with the housing, wherein the collection chamber is in fluidconnection with the tissue-removal assembly through a lumen of theshaft.
 5. The surgical device of claim 4, wherein the collection chambercomprises one or more collection ports having one or more removable capsor plugs, wherein the one or more collection ports enable transportingof removed tissues and fluids.
 6. The surgical device of claim 1,wherein the drive system comprises one or more motors controlled by thesurgical robotic system, the one or more motors being at least one of avariable speed or constant speed motor.
 7. The surgical device of claim1, further comprising an outer tube enclosing at least a part of theshaft, wherein an end portion of the outer tube includes a tip with acutting edge, the tip of the end portion of the outer tube beingdisposed closer to the tissue-removal assembly than to the drive system.8. The surgical device of claim 7, wherein the end portion of the outertube having the tip has a cross-sectional dimension that is larger thanthat of other portions of the outer tube.
 9. The surgical device ofclaim 7, wherein the end portion of the outer tube having the cuttingedge is a beveled end portion, and the end portion increases indimension toward the tip of the end portion of the outer tube.
 10. Thesurgical device of claim 1, wherein the shaft includes an elongatedmember with screw threads configured to transport removed tissues. 11.The surgical device of claim 1, wherein the first cutting memberincludes an elongated member and wherein the plurality of rotatableblades are formed along the longitudinal direction of the elongatedmember of the first cutting member.
 12. The surgical device of claim 1,wherein the plurality of rotatable blades forms a plurality offlow-control surfaces between the blades, and wherein a cross-section ofthe first cutting member forms a polygon.
 13. The surgical device ofclaim 12, wherein the cross-section of first cutting member forms astar-shaped polygon, the star-shaped polygon comprising one of five-,six-, seven-, eight-, nine-, or ten-protrusions or angles correspondingto the rotatable blades along the longitudinal direction of theelongated member of the first cutting member.
 14. The surgical device ofclaim 1, wherein the one or more support elements are independentlyadjustable from the length and position of the one or more extendableelements.
 15. The surgical device of claim 1, wherein the one or moreextendable elements comprises a looped extendable element insertedthrough an inner portion of the second cutting member.
 16. The surgicaldevice of claim 1 wherein the one or more support elements and one ormore extendable elements are controllable by the surgical robotic systemto configure the tissue removal assembly to a plurality of differentprofiles.
 17. A surgical robotic system comprising: a roboticcontroller; a robotic arm controlled by the robotic controller; asurgical device coupled to the robotic arm, wherein the surgical devicecomprises: a drive system electrically coupled to the robotic arm; ashaft rotatably coupled to the drive system at a first end of the shaft;a tissue-removal assembly coupled to a second end of the shaft, whereinthe tissue-removal assembly comprises: a first cutting member having aplurality of rotatable blades, wherein the first cutting member iscoupled to the second end of the shaft, a second cutting member, one ormore support elements slidably or fixedly coupled to the second cuttingmember, wherein the one or more support elements comprises a loopedsupport element inserted through an inner portion of the second cuttingmember, and one or more extendable elements slidably or fixedly coupledto the second cutting member, wherein the one or more support elementsand the extendable elements are extendable and retractable to adjust theposition of the second cutting member with respect to the first cuttingmember.
 18. The surgical robotic system of claim 17, wherein theplurality of rotatable blades forms a plurality of flow-control surfacesbetween the blades, and wherein cross-section of the first cuttingmember forms a star-shaped polygon.
 19. The surgical robotic system ofclaim 17, further comprising: a localizer; and one or more trackingdevices, wherein the combination of the localizer and the one or moretracking devices provide signals for tracking at least the surgicaldevice.
 20. A surgical device controllable by a surgical robotic system,comprising: a housing capable of being coupled to the surgical roboticsystem; a drive system at least partially mounted in the housing; ashaft rotatably coupled to the drive system at a first end of the shaft;a tissue-removal assembly coupled to a second end of the shaft, whereinthe tissue-removal assembly comprises: a first cutting member having aplurality of rotatable blades, wherein the first cutting member iscoupled to the second end of the shaft, a second cutting member, one ormore support elements slidably or fixedly coupled to the second cuttingmember, and one or more extendable elements slidably or fixedly coupledto the second cutting member, wherein the one or more extendableelements comprises a looped extendable element inserted through an innerportion of the second cutting member, wherein the one or more supportelements and the extendable elements are extendable and retractable toadjust the position of the second cutting member with respect to thefirst cutting member.